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Innovation

Use of artistic activities on hospital wards to enhance wellbeing

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At Aintree University Hospital, art students and student nurses offer creative ward-based activities, gaining valuable work experience while enhancing patient and staff wellbeing

Abstract

Aintree University Hospital has partnered with Liverpool John Moores University to create a programme of ward-based art activities delivered by students from various disciplines. In parallel, the two institutions have set up a work-based learning programme for the students involved. Through the Arts Loco project, patients experience improved wellbeing and function, staff benefit from reduced stress levels, and students gain valuable work experience. This article describes the project’s background, development and achievements.

Citation: McNeill E et al (2018) Use of artistic activities on hospital wards to enhance wellbeing. Nursing Times [online]; 114: 8, 57-59.

Authors: Elaine McNeill is researcher and student development coordinator at Liverpool School of Art and Design, Liverpool John Moores University; Paula O’Malley is healing arts manager at Aintree University Hospital; Steve Lee is staff nurse at the complex rehabilitation unit, The Walton Centre, Liverpool.

  • This article has been double-blind peer reviewed 
  • Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)

Introduction

Many hospitals in the UK incorporate art into their environment – in corridors, waiting areas, gardens and clinical areas. In fact, it is rare to see a hospital void of artwork. However, beyond the decorative benefit of displays on hospital walls, art can also promote patient recovery and improve staff wellbeing. Over the last 20 years, there has been growing interest in using the arts in therapeutic interventions. This article describes the development of a sustainable ‘arts in health’ partnership between Aintree University Hospital and Liverpool John Moores University.

Benefits of art interventions

There is a wealth of research and anecdotal evidence showing that the arts can have a positive effect on health outcomes (Staricoff, 2004), which is reflected in Clift and Camic’s (2015) Oxford Textbook of Creative Arts, Health and Wellbeing. Ward-based art activities can support recovery by improving mental health and wellbeing. They provide patients with an outlet for creativity and an opportunity for social interaction. Art interventions in traditional healthcare settings have been shown to:

  • Improve communication;
  • Increase a sense of empowerment;
  • Temporarily relieve symptoms such as pain and depression (British Medical Association, 2011).

Health professionals across the world believe that creative ward-based activities can have a positive effect on patients’ health. In Japan, holistic ways of caring for patients are becoming more widespread, with student groups developing art programmes aimed at reducing stress (Fondevilla and Iwata, 2016). In the US and Australia, hospitals have art programmes and artists in residence (National Organization for Arts in Health, 2017; New South Wales Government, 2016).

A recent literature review looked at 27 articles about art interventions in healthcare settings using music, dance, visual arts, reading and creative writing (Wilson et al, 2016). A majority of staff believed the interventions improved patients’ wellbeing and enhanced communication with them. The interventions were perceived as:

  • Reducing patients’ stress and pain;
  • Improving their mood and sleep.

They were also thought to benefit staff, who had:

  • Less stress and burnout;
  • Improved mood and wellbeing;
  • An enhanced work environment and better performance at work.

Art in Aintree University Hospital

Aintree University Hospital in Liverpool provides general acute healthcare to 330,000 people in North Merseyside and the surrounding areas. It has 14 adult acute wards, 11 adult continuing care wards and five adult rehabilitation/older people’s wards. In response to an increasing number of patients who are unable to be discharged because they require care plans, the hospital has created an interim care service, Aintree 2 Home. This involves patients who no longer require acute hospital care being transferred to a ward with a multidisciplinary team.

Since September 2007, Aintree University Hospital has a healing arts department called Promoting Art In Aintree (PARTIA), which offers patients a wide range of artistic activities in collaboration with student volunteers from various disciplines. The hospital has developed strong links with Liverpool John Moores University and, between September 2013 and January 2014, Elaine McNeill, student development coordinator at the Liverpool School of Art and Design, visited the hospital weekly to research art practice as part of her PhD.

‘Arts in health’ partnership

During her work with PARTIA, Elaine McNeill observed the huge benefits of arts on the patient experience and healing process. Meanwhile, at the university, the demand from students for work experience to support a career progression into art therapy was increasing.

In 2015, the Arts Loco project was set up as an ‘arts in health’ partnership between the two institutions. Our aims were to:

  • Create a sustainable model of art activities for patients;
  • Provide valuable work experience for students;
  • Develop an effective work-based learning programme for students.

The Arts Loco project has generated a wide programme of engaging art activities in the hospital’s mainstream inpatient wards, predominantly for older patients. During the second academic semester (January to March), the student groups offer at least four ward-based art sessions; several students also become hospital volunteers and offer additional sessions. Boxes 1-3 give examples of the sessions and activities that are offered.

Box 1. The Art Trio

arts pic1

Students from Liverpool School of Art and Design and the School of Psychology and Natural Sciences proposed a painting activity under the name the Art Trio. With their help, patients on ward 34, patients in the frailty unit at the Department of Medicine for the Elderly, and patients receiving support from Aintree 2 Home created simple watercolours and landscape paintings with washes of colour (pictured right). The activity allowed patients to relax, tap into their creativity and have stimulating conversations with visitors and staff.

Box 2. Vinyl Images

arts pic2

The idea behind Vinyl Images was to offer fun and entertainment with a 1960s theme. A team of student nurses and fine art and psychology students dressed in ’60s-style clothes, with wigs and tie-dye costumes (pictured right), and visited the wards armed with a sound system. They would invite patients to select their favourite tunes, perform basic dance routines to the chosen music and teach those moves to patients. Sometimes staff would join in – testament to Vinyl Images’ ability to create a fun environment.

Box 3. The Twinsets

arts pic3

The Twinsets dressed in vintage clothes and visited wards to sing and read poetry familiar to older patients (pictured right). This type of guided reminiscence activity can be particularly effective with people living with dementia; it is not uncommon to see people who rarely or never speak join in singing songs from their era.

For patients, particularly those on long hospital stays, the activities offer a welcome distraction from the daily ward routine. By encouraging them to engage, we also aim to:

  • Maintain their functional ability;
  • Reduce their deconditioning;
  • Lower their anxiety about discharge while they are waiting to go home and are receiving support from Aintree 2 Home.

For students, the activities provide practical experience in a clinical setting, giving them the opportunity to apply their creativity, life skills and knowledge to practice. This is crucial for those who would like to pursue a career in art therapy: 1,500 hours’ work experience are required to apply for an MA in the field.

For staff, the activities are an opportunity to get to know patients and interact with them in a different way. Often, addressing the physical care needs of older patients, particularly those with dementia, leaves little time to get to know the person behind the illness. Creative activities can reveal a patient’s character and personality.

Work-based learning programme

The Arts Loco project supports the professional development of students from various fields – primarily nursing, psychology, and artistic/creative disciplines such as fine arts, creative writing, fashion, drama and media studies. Student nurses on the Arts Loco project are volunteering as part of student mentoring programme.

The approach adopted by Arts Loco is to use best-practice principles, such as person-centredness, to improve the patient experience. Before students can start offering activities on the wards, we also have to ensure they fully understand the principles of infection prevention and control, as well as ethics and good practice in relation to working with vulnerable adults in an acute care setting (safeguarding).

To this effect, we have developed a work-based learning programme. Spread across eight weeks, it uses an interdisciplinary, learner-centred approach that promotes the long-term retention of arts and health concepts.

The 30-hour programme is delivered in partnership between the student development coordinator, the healing arts manager, and a nursing academic. With up to 30 students in each cohort, we cover topics such as arts and health best practice, safeguarding, effective communication and evaluation. After undertaking the programme, students can intervene autonomously on the wards.

The interdisciplinary nature of the student groups produces a dynamic environment in which everyone learns from each other. Those studying nursing or psychology bring their knowledge of healthcare practice, while art students encourage their peers in healthcare disciplines to recognise, use and enjoy their creativity.

Outcomes

Using an arts observation technique and informal feedback from staff, we gathered information on the impact on the patient experience. We also invited students to complete an online questionnaire. This was conducted in 2015 and was sent to 18 students, 10 of whom responded.

The outcomes show that the interventions improved both patient and staff wellbeing. Patients and staff reported that the art sessions provided fun, relaxation, socialisation, creativity and a sense of belonging. Improvements were noted in patients’ ability to manage self-care and in their overall quality of life. For staff, there was a noticeable reduction in stress levels; some ward managers have used daily art sessions to improve staff morale.

Feedback from students showed that they recognised the benefits of a holistic approach to healthcare.

Over three years we have engaged up to 70 students and a number of graduates have developed careers in the field of arts and health, including in roles such as: wellbeing coordinator, activities coordinator, drama practitioner and hospital arts practitioner.

Arts Loco was nominated in the 2017 Learning Matters Awards. Steve Lee, former student nurse who now works in the complex rehabilitation unit at The Walton Centre in Liverpool, was also nominated. By engaging in the Arts Loco project, he found that he could use his passion for music and love of dance in his work:

“For me, every step of the way, there has always been music and dancing involved. […] I have seen how dancing lifts the atmosphere in the hospital. I was the DJ for the Christmas dinner and I had all staff up dancing – even a couple of patients managed it!”

Challenges

One challenge was that, in acute hospitals, it is often difficult to engage patients. We found it took a lot of time and energy to motivate patients initially, but once they were involved their motivation increased significantly. As their confidence and self-esteem grew, they became more keen to pursue creative activities.

Another source of difficulty was funding. Given the NHS’s current financial constraints, our idea was to create a sustainable model based on collaboration with the local university and voluntary participation from students. Students have indeed been of great help, allowing us to offer creative activities to patients at little cost. However, the issue of ongoing funding will continue to threaten the project’s success. Arts Loco has been delivered through goodwill and previously benefited from donations of materials from art suppliers, Cass Art. With a small amount of funding Arts Loco could provide huge benefits, support the patient experience and reduce length of hospital stay.

We currently have a small reach across the hospital and focus mainly on the Department of Medicine for the Elderly. However, Arts Loco has the potential to bring together a range of community assets to improve population health. Edge Hill University is planning to adopt the model for its student nurses and we are also in discussions with housing associations to develop the model for community and primary care.

Conclusion

Establishing a successful art project in a healthcare environment requires strong partnerships, appropriate training and staff cooperation. Sustainability is key. Arts Loco is valuable in many ways. It provides work experience to students from a range of disciplines and gives an insight into a range of patient needs that physical care alone does not address. More art interventions should be available to complement clinical care in hospital and other healthcare settings. 

Key points

  • Over the last 20 years, there has been growing interest in using the arts in therapeutic interventions
  • Ward-based art activities in hospital can support patient recovery by improving wellbeing and function
  • Creative activities can reveal patients’ personalities, thereby helping ward staff to know them better
  • Art students can gain valuable work experience by volunteering to offer ward-based art activities
  • There should be more art interventions complementing clinical care in hospitals
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